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D 4-- <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION �Gcf22iL <br />DATE <br />UNDERGROUND TANK INSPECTION RECORD <br />PPROVED <br />INITIALS <br />. UL numbers —3 1 3f2A tank size <br />NEW TANK INSTALLATION <br />K <br />SITE NAMES A <br />INSPECTOR'S <br />NAME G$> q <br />o <br />� <br />CITY <br />21P <br />QP. <br />1j <br />i� <br />6. Permit to operate application complete. <br />CONTRACTOR: NAME <br />b. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />PHONE <br />OWNER: NAME <br />�ry <br />(.-� r <br />PHONE <br />D 4-- <br />DIS <br />INSPECTOR'S <br />INITIAL INSPECTION �Gcf22iL <br />DATE <br />kPPROVED <br />PPROVED <br />INITIALS <br />. UL numbers —3 1 3f2A tank size <br />K <br />3. Overfill rotection installed, descri �5 <br />ITEM OR EQUIPMENT INSPECTED <br />t'to` <br />t <br />o <br />� <br />fees paid <br />QP. <br />1j <br />i� <br />6. Permit to operate application complete. <br />Plans Approved <br />D 4-- <br />7/ <br />S <br />�t <br />NG STAGE INSPECTION `'—� �'� <br />1. Pressure test of piping. [Primary and a ondary (NEPA 30)) <br />INITIAL INSPECTION �Gcf22iL <br />2. Spill protection at fill pipe. <br />2. Ball float valves installed. <br />. UL numbers —3 1 3f2A tank size <br />K <br />3. Overfill rotection installed, descri �5 <br />. Tank tested upon delivery (Holiday (plasteel) or lr_a PSI R I <br />t'to` <br />t <br />o <br />� <br />. Visual inspection of secondary containment. <br />. Tank appropriately placed with approved backfill. <br />1j <br />i� <br />6. Permit to operate application complete. <br />7/ <br />S <br />�t <br />NG STAGE INSPECTION `'—� �'� <br />1. Pressure test of piping. [Primary and a ondary (NEPA 30)) <br />2. Spill protection at fill pipe. <br />2. Ball float valves installed. <br />K <br />3. Overfill rotection installed, descri �5 <br />4. Performance test of product line leak detector. (Hard wired) <br />4. Unused tank opening sealed and cathodicatly protected. <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />5. visual inspection of secondary containment on piping. <br />6. Permit to operate application complete. <br />b. Monitoring ports in place and brought to grade. (lockable weather proof covers) <br />7. Acceptable recordkeeping system. <br />7. Fill and vent piping brought to grade. <br />8. Product line leak detector in place. (Hard wired) <br />K <br />9. Approved tank leak monitoring device installed. <br />i <br />10. All galvanized piping and fittings properly wrapped. <br />3 <br />1. Pressure decay test on complete tank and product delivery system. <br />Comments: <br />FINAL INSPECTION <br />1. Precision test successfully completed and hard copies received. (NEPA 329) <br />2. Spill protection at fill pipe. <br />3. Performance test of overfill protection system. <br />$10 <br />4. Performance test of product line leak detector. (Hard wired) <br />5. Performance test of continuous monitoring system(s) on tank (s) <br />6. Permit to operate application complete. <br />7. Acceptable recordkeeping system. <br />Comments: <br />